Human Papillomavirus Vaccination Uptake in the Rio Grande Valley: Results from a Pilot Community-Based Educational and School-Based Vaccination Program and Its Expansion.

Human papillomavirus (HPV) vaccine is a safe and effective strategy for reducing HPV morbidity and mortality. Schools have become an increasingly attractive setting for delivering vaccinations and supporting vaccination health literacy and decisional support. This study assesses the effectiveness of a community-based, physician-led HPV education campaign (starting in 2016) and onsite middle school-based HPV vaccination program across six school districts (2017, 2019, 2020) in a rural, medically underserved Texas area (Rio Grande Valley). Pre- and post-intervention HPV vaccination rates were tracked against the 2016 National Immunization Survey-Teen target rates (initiation: 49.3%; completion: 32.9%). Summary statistics were stratified by gender, school district, and grade level. The study reached 19,951 students who received HPV vaccines directly or indirectly through our program (10,289 females; 9662 males) (August 2016-August 2022). Of those, 2145 students (1074 females; 1071 males) were vaccinated directly through our program. The overall HPV up-to-date (UTD) rates were 58.8%. The overall median age at HPV vaccine initiation and HPV-UTD (range) was 11 years (9-21) and 12 years (9-20). The overall median interval between HPV vaccine doses (range) was 291 days (146-2968). Recommending HPV vaccine initiation at younger ages increases HPV vaccine completion and providing access to HPV vaccines encourages on-time vaccination and completion.

Human papillomavirus vaccinations at recommended ages: How a middle school-based educational and vaccination program increased uptake in the Rio Grande Valley.

Human papillomavirus (HPV) vaccination is recommended for U.S. adolescents at ages 11-12 requiring two or three doses depending on if the vaccine series started before age 15. The objective was to compare HPV vaccination rates among medically underserved, economically disadvantaged, students in rural middle school districts (Rio Grande Valley [RGV], Texas) by age of initiation (≤ age 11 years vs. age 12 years and older). This quasi-experimental study included 1,766 students (884 females; 882 males) who received at least one HPV vaccine dose through our school-based vaccination program between 08/2016-06/2022. Summary statistics were stratified by age at initiation and gender. The overall HPV up-to-date (UTD) rate was 59.7% (95% Confidence Interval: 57.4-62.0%). The median age at HPV UTD (range) was 12 years (9-19) and median interval between HPV vaccine doses (range) was 316 days (150-2,855). Most students received the HPV vaccine bundled with other vaccinations (72.4%, 1,279/1,766). There was a higher HPV UTD rate among students who initiated the HPV vaccine on or before age 11 than those who initiated on or after age 12 (73.6% versus 45.1%, respectively). The median age of HPV UTD was age 12 for those initiating on or before 11 years versus age 13 for those initiating on or after 12 years of age. Initiating the HPV vaccine at age ≤11 years increased completion of the HPV vaccine series. Improving HPV vaccine coverage and introduction of pan-gender vaccination programs will significantly decrease HPV-related diseases in the RGV.

Human Papillomavirus Vaccinations During the COVID-19 Pandemic in Middle Schools in the Rio Grande Valley of Texas.

This quasi-experimental study (a community-based, physician-led human papillomavirus [HPV] education campaign and school-based vaccination program) followed 6481 students at eight Pharr-San Juan-Alamo Independent School District (Rio Grande Valley, Texas) middle schools between August 2016 and March 2021. We describe the successes and challenges experienced during the COVID-19 pandemic. HPV vaccine initiation and completion rates increased 1.29-fold and 1.47-fold, respectively, between June 2019 and March 2021. Between March 2020 and March 2021, 268 HPV vaccine doses were provided through 24 school-based interventions. Our program continued successes seen in increasing HPV vaccination rates and reducing possible HPV-associated cancers. (Am J Public Health. 2022;112(9):1269-1272. https://doi.org/10.2105/AJPH.2022.306970).

Characterization of individuals with selected muscular dystrophies from the expanded pilot of the Muscular Dystrophy Surveillance, Tracking and Research Network (MD STARnet) in the United States.

INTRODUCTION: Data on muscular dystrophies (MDs), a heterogeneous group of heritable diseases hallmarked by progressive muscle deterioration, are scarce. OBJECTIVE: We describe cross-sectional sociodemographic and clinical characteristics of individuals with congenital, distal, Emery-Dreifuss, facioscapulohumeral, limb-girdle, myotonic, or oculopharyngeal MD. METHODS: The study was conducted in four sites (Arizona, Colorado, Iowa, and 12 western New York counties) as a pilot expansion of the Muscular Dystrophy Surveillance, Tracking and Research Network, funded by the Centers for Disease Control and Prevention. MDs were detected in healthcare facilities and administrative data sources using International Classification of Disease codes. Our sample contains 1,723 individuals with a MD diagnosis and a healthcare encounter between January 1, 2007 and December 31, 2011. RESULTS AND CONCLUSIONS: Individuals were mostly non-Hispanic and white. Median ages ranged from 9.2 to 66.0 years. Most (98%) had health insurance. The proportion of individuals who were disabled or unable to work increased with age (range: 8.6-46.4%). People with limb-girdle MD aged ≥18 years were more likely to be nonambulatory (range: 24.5-44.7%). The percentages of individuals with documented clinical interventions during the surveillance period were low. The most common cause of death was respiratory causes (46.3-57.1%); an ICD-10 code for MD (G71.1 or G71.0) was reported for nearly one-half. Our findings show wide variability in sociodemographic and clinical characteristics across MDs.

Fragile X Syndrome-Associated Emergency Department Visits in the United States, 2006-2011.

Using national data, we examined emergency department (ED) encounters during 2006-2011 for which a diagnosis code for fragile X syndrome (FXS) was present (n = 7,217). Almost half of ED visits coded for FXS resulted in hospitalization, which is much higher than for ED visits not coded for FXS. ED visits among females coded for FXS were slightly more likely to result in hospitalization. These findings underscore the importance of surveillance systems that could accurately identify individuals with FXS, track healthcare utilization and co-occurring conditions, and monitor quality of care in order to improve care and reduce FXS-associated morbidity.

Private Insurance Reimbursements for Newborn Hearing Screening in the United States, 2013-2014 Birth Cohort.

The purpose of this study was to describe private insurance reimbursements for newborn hearing screening (NBHS) in the United States. Data from the MarketScan® Commercial Databases were used to estimate itemized reimbursements for privately insured infants born between January 1, 2013-December 31, 2014. Estimates were based on billed claims for hearing screening services during infancy among 456,407 infants with birth hospitalization claims (71,820 infants with inpatient NBHS and 1,104 infants with outpatient NBHS). The median reimbursement for NBHS was almost three times greater when performed in an inpatient setting than outpatient setting. Median reimbursement for NBHS performed in a hospital and billed as inpatient service was $148.00 (interquartile range [IQR] $99.52-$210.00) and $57.53 (IQR $34.40-$120.91) when billed as an outpatient service. The mean reimbursement for NBHS performed in an outpatient hospital setting was $136.48 (IQR $86.08-$220.15) and $41.60 (IQR $28.15-$57.52) for NBHS billed in conjunction with an office visit (e.g., performed in an audiology clinic, an audiologist's office, or physician's office during a routine check-up). No NBHS claims were filed for 84.3% of infants (384,587‬/456,407), as NBHS is generally included as a covered service bundled along with delivery and newborn care.

School-based human papillomavirus vaccination program for increasing vaccine uptake in an underserved area in Texas.

OBJECTIVE: Compare the effectiveness of community-based HPV-related education and onsite school-based vaccination versus community-based education only for increasing HPV vaccine uptake in a rural, medically underserved area. METHODS: Our cohort included 2307 Rio Grande City Consolidated Independent School District (RGCISD) middle school students from 3 schools enrolled in August 2016 and followed until April 2018. Using a quasi-experimental design, this study implemented an onsite school-based vaccination program and physician-led education on HPV and HPV vaccines for parents/guardians, school nurses/staff, and pediatric/family providers in the surrounding community (15-mile radius of RGCCISD) at 1 middle school ("intervention school"), and education-only for the remaining 2 schools ("comparison schools"). The Centers for Disease Control and Prevention's HPV-related educational materials supplemented the education. HPV vaccine status was obtained from school immunization records and the project's contracted vaccine vendor. HPV vaccine initiation and completion rates were compared pre and post intervention and between the intervention and comparison schools. Logistic regression was used to compare the odds of newly initiating/completing vaccination between the intervention and comparison schools. RESULTS: At baseline, the intervention school had lower HPV vaccine initiation and completion rates than the comparison schools (20.00% and 8.70% vs 28.97% and 14.56%). Post intervention, the intervention school had higher initiation and completion rates than the comparison schools (53.67% and 28.36% vs 41.56% and 20.53%). Students from the intervention school were over 3.6-times more likely to newly initiate/complete the HPV vaccinations than students from the comparison schools. CONCLUSION: The school with on-site vaccination events and community-based education had a higher adolescent HPV vaccination rate compared to schools that received community-based education only.

Parental knowledge gaps and barriers for children receiving human papillomavirus vaccine in the Rio Grande Valley of Texas.

Purpose: Despite its availability for more than a decade, the human papillomavirus (HPV) vaccine has low uptake in Texas (49%). The objective of this study was to understand parental knowledge and attitudes about HPV and the HPV vaccine as well as child experience with the HPV vaccine among a medically underserved, economically disadvantaged population. Methods: As part of a Cancer Prevention Research Institute of Texas-funded project to improve HPV vaccination rates, we surveyed parents / guardians of 4th-12th graders (ages 9-17) in the Rio Grande City Consolidated Independent School District (RGCCISD). Descriptive statistics were used to describe parents' knowledge and attitude and children's vaccine experience. Results: Of the 7,055 surveys distributed, 622 (8.8%) were returned. About 84% of the respondents were female. About 57.1% of the parents /guardians had female RGCCISD students with a mean age of 11.7 ± 1.8 years. Overall, 43.9% reported receiving a healthcare provider recommendation and 32.5% had their child vaccinated. Higher percentages were reported if the respondent was female and had a female child aged ≥15 years old. Among survey respondents, 28.2% reported their child initiated the HPV vaccine and 18.8% completed the series. Barriers of uptake included work / school schedule conflicts and no healthcare provider recommendation. Conclusions: There are still prominent gaps in parents' and students' complete understanding of HPV vaccination, gender preferences for vaccination, and provider recommendations. Future interventions must target men and minority populations in order to increase knowledge and awareness about HPV, the HPV vaccine, and HPV-associated cancers.

Human Papillomavirus Vaccine Interventions in the U.S.: A Systematic Review and Meta-analysis.

CONTEXT: Despite current recommendations, human papillomavirus vaccine uptake remains low. A systematic review and meta-analysis assessed the effectiveness of interventions targeting human papillomavirus vaccine initiation and completion among children, adolescents, and young adults aged 9-26 years. EVIDENCE ACQUISITION: Three electronic databases (CINAHL, OVID, and Web of Science) were searched for articles published in English peer-reviewed journals between January 2006 and January 2017 of U.S. studies that evaluated intervention strategies and reported post-intervention human papillomavirus vaccine initiation or completion rates among individuals aged 9-26 years. Study characteristics and outcomes were extracted. Data were collected in 2016 and analyzed in 2017. EVIDENCE SYNTHESIS: Reviewers screened 983 unique titles and abstracts, read 241 full-text articles, and extracted data from 30 articles meeting the inclusion criteria (12 behavioral, ten environmental, four informational, and four combination strategies). Published EQUATOR (Enhancing the Quality and Transparency of Health Research) guidelines were used to assess study quality. Random effects meta-analyses were conducted. The meta-analyses included 17 RCTs and quasi-experiments involving 68,623 children, adolescents, and young adults. The pooled relative incidence estimates were 1.84 (95% CI=1.36, 2.48) for human papillomavirus vaccine initiation and 1.50 (95% CI=1.23, 1.83) for completion. Behavioral and informational interventions doubled human papillomavirus vaccine initiation (relative incidence estimate=2.04, 95% CI=1.36, 3.06 and relative incidence estimate=1.92, 95% CI=1.27, 2.91, respectively). Behavioral interventions increased completion by 68% (relative incidence estimate=1.68, 95% CI=1.25, 2.27). CONCLUSIONS: Evidence supports behavioral interventions for increasing human papillomavirus vaccine initiation and completion. Future studies are needed to assess the effectiveness of interventions in reaching diverse populations and reducing missed opportunities for human papillomavirus vaccination.

Healthcare expenditures for privately insured US patients with cystic fibrosis, 2010-2016.

OBJECTIVES: Published cost estimates for cystic fibrosis (CF) are based on older data and do not reflect increased use of specialty drugs in recent years. We assessed recent trends in healthcare expenditures for CF patients in the United States (US) with employer-sponsored health insurance. METHODS: The study is a retrospective analysis of claims data for privately insured individuals aged 0-64 years who were continuously enrolled in non-capitated plans for at least 1 calendar year during 2010-2016. Mean annual expenditures during a calendar year were calculated for individuals who met a claims-based CF case definition. Average annual growth rates were calculated through linear regression of the natural logarithm of annual expenditures. RESULTS: The annual CF prevalence was 1.1-1.4 per 10 000 adults and 2.9-3.0 per 10 000 children. Average spending adjusted for inflation nearly doubled from roughly $67 000 per patient in 2010 and 2011 to approximately $131 000 per patient in 2016. Inflation-adjusted spending on outpatient and inpatient care increased by 0.5% and 2.5% per year, respectively, whereas pharmaceutical spending increased by 20.2% per year. Virtually all of the growth in pharmaceutical spending was accounted for by spending on specialty drugs; inflation-adjusted spending on other medications increased by 1.3% per year. The annual growth rate in pharmaceutical spending rose by 33.1% during 2014-2016, the years during which lumacaftor/ivacaftor was introduced. CONCLUSIONS: Per-patient expenditures for privately-insured patients with CF almost doubled during 2010-2016; specialty drugs were largely responsible for this increase, with a major contribution from new, genotype-targeted CFTR modulator medications.